September 12-13, 2015
Plain, Washington

    Registration Form & Waiver(sign & date, and mail)

    First Name: Age:

    Last Name:   Male Female               

   City: State:     Zip:

   Emergency Phone:   Your Phone:

   Allergies & Medical:

    E-Mail Address:

    Pre Race Dinner Yes   No   Number of Guests@$10 pp:

    Qualifying Race/Date:      Time:

(Check payable to Cascade Running Club)

Cost: $90 pp 100K and $120 pp 100M, $10 guest dinner. Registrations may be accepted beyond September 9, subject to availability. Cancellation: prior to September 9, $85/$115 refund respectively. After September 9, no refund.
check enclosed $

Please read the following before signing - WAIVER: In consideration of your accepting this entry, I hereby for myself, my heirs, and executors, waive any and all claims that I may have against any and all persons and organizations affiliated with this event, including but not limited to organizaers and supporters, USATF, PNTF, Cascade Running Club and any sponsers, while traveling to or from and participating in the Plain 100 Endurance Runs.

    Signature :   ___________________________________________________________

    Date: _______________________________

Return Entry with Payment by 9/9/15 to:
Cascade Running Club
PO Box 218, Kirkland, WA 98083-0218


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